Prosthodontic Complications Research Articles

Implant Treatment by Guided Surgery Supporting Overdentures in Edentulous Mandible Patients.

Introduction: This study aimed to show the clinical outcomes of implants inserted by guided surgery supporting mandibular overdentures in edentulous patients. Patients and methods: Mandibular edentulous patients were diagnosed with an oral examination, cone-beam computerized tomography, and diagnostic casts for intermaxillary relations and treated with overdentures over two implants by guided surgery. After flapless surgery, implants were early loaded with an overdenture at 6 weeks. Results and discussion: Fourteen patients (nine females and five males) were treated with 28 implants. Four patients (28.6%) had a previous history of periodontitis. Five patients (35.7%) were smokers. Nine patients (64.3%) suffered from systemic diseases (i.e., diabetes, cardiovascular diseases). The clinical follow-up of the study was 44.7 ± 31.4 months. Clinical outcomes showed a global success of 100% of implants. Fourteen overdentures were placed in the patients over the implants. Mean marginal bone loss was 1.25 mm ± 0.95 mm. Four patients (28.6%) showed some kind of mechanical prosthodontic complications. Six implants (21.4%) were associated with peri-implantitis. Conclusions: This study indicates that treatment of mandibular edentulous patients with overdentures by guided surgery and early loading of implants placed appears to be a successful implant protocol.

Implant Impression Making: Take-Off Guide for Beginners

AbstractDental implants are fixtures that constitute for the replacements of the root of a missing natural tooth. Dental implant therapy has been widely used for the restoration of partially and fully edentulous patients. The implant literature emphasizes the importance of a passively fitting prosthesis to prevent prosthodontic complications or even loss of fixture integration. Failure to achieve a passively fitting prosthesis and force tightening of superstructure may result in complications such as abutment, framework, and gold screw loosening or fracture. Various materials that can be used for making an implant impression are polyether, polyvinylsiloxane, condensation silicone, polysulfide, irreversible hydrocolloid material, and various others. There are various studies in relation to the accuracy of these impression materials out of which various scientists concluded different results with most studies stating polyether with the maximum amount of dimensional accuracy in comparison to other materials. An accurate implant impression plays a significant role and serves as a starting point in the process of producing good working casts. Thus, the accuracy of impression techniques becomes a significant issue in consideration of passive fit. Reproduction of intraoral relationship of implants through impression procedures is the first step in achieving accurate fit prosthesis. This transference is still complicated by the number, angulation, depth, and position of implants. The advent of computer-aided design/computer-assisted manufacturing technology improved the framework fabrication procedures and has increased the precision of fit of implant prosthesis.

Prosthodontic complications during implant-based oral rehabilitation of patients with head and neck cancer

Statement of problemImplant-retained prosthodontic rehabilitation of patients with head and neck cancer is complex. However, the extent of prosthodontic complications has been sparsely reported within the literature. PurposeThe purpose of this retrospective study was to describe the range of complications and issues that affected the oral rehabilitation treatment of patients with head and neck cancer who had completed implant-retained prosthodontic rehabilitation in a tertiary treatment center. Material and methodsA retrospective analysis of complications and their consequences in patients treated in a regional unit from 2012 to 2017 was performed. Descriptive analysis was carried out on the type and frequency of complications and their consequences for the patients’ treatment. Complications were grouped into the following complication types: local and systemic, implant, peri-implant soft tissue, and clinical prosthodontic complications. Implant success and implant survival were also reported. ResultsThe sample was composed of 163 patients with head and neck cancer who had completed implant-retained prosthodontic rehabilitation. Local and systemic complications affected 8.6% of patients, and peri-implant soft-tissue complications affected 9.8% of patients. Clinical prosthodontic complications leading to repeated clinical or laboratory stages occurred on 48 occasions in 45 patients (27.6% of patients). A total of 763 implants were placed. Implant survival was 95.8% and implant success 94.5%, with a mean follow-up of 42.1 months. ConclusionsThis retrospective evaluation indicated that complications arising during the process of implant-retained prosthetic rehabilitation in this patient group were variable and common. Such complications can delay the process of treatment and lead to repeating or restarting clinical and laboratory stages of treatment.

Botulinum toxin and occlusal splints for the management of sleep bruxism in individuals with implant overdentures: A randomized controlled trial

BackgroundThe available treatment options fail to provide definitive or curative management for bruxer patients rehabilitated with implant overdentures (OD). The data regarding Botulinum toxin (BTX) injection as a management strategy for bruxism remains unclear. This randomized, single-blinded, control-group, pretest–posttest prospective trial evaluated the occlusal guard and Botox injections (BTX) effectiveness in managing sleep bruxism (SB) in subjects whose one of the edentulous arches had been restored with the implant-supported OD. MethodsForty-two patients diagnosed with definite bruxism were selected, all of which had implant-retained ODs opposing natural dentition. The participants were allocated randomly to three equal groups. Participants in group I (control group) were instructed to remove the OD at night; group II was managed with conventional occlusal stents. Those in group III were given BTX injections. New ODs were constructed for all groups, and all ball attachments were replaced with a new nylon cap. A baseline assessment (one month of OD insertion) of patient satisfaction and sleep quality was conducted, and then again at 3, 6, 9, and 12 months of treatment. Subjective sleep quality was evaluated using Pittsburgh Sleep Quality Index (PSQI). Patients’ satisfaction was evaluated using Temporomandibular disorders/numeric scales (TMD/NS). Prosthodontic (mechanical) complications were recorded during the follow-up period. ResultsGroup III showed a statistically significant improvement in patient satisfaction and sleep quality compared to the other two groups at 3, 6, 9, and 12 months follow-up period (P = 0 0.001, 0.0001, 0.0013, and 0.0001 respectively). Regarding prosthodontic (mechanical) complications, the highest number of events was revealed in the control group. ConclusionsBTX and occlusal appliances effectively improve patient satisfaction and sleep quality of Bruxer patients rehabilitated with single arch implant overdentures.

Prosthetic Maintenance and Peri- Implant Tissues Conditions of Fixed Screw- Retained Implant Prosthesis Versus Implant-Retained Ball Overdentures: A Randomized Clinical Trial

The aim of the study is to compare the prosthetic maintenance requirements between implant-retained ball overdentures versus fixed screw-retained implant prosthesis. Clinical and radiographic changes in peri-implant tissue with using PGE2 as a peri-implant crevicular fluid (PICF) biomarker were also evaluated. 54 completely edentulous patients were enrolled: group I, 27 patients were rehabilitated with fixed screw retained restorations; group II, 27 patients with ball retained implant overdenture. Prosthodontic complications were calculated. The clinical parameters were recorded and PICF was collected at baseline, 6- and 12-months postoperatively. There was no statistically significance difference between group I and group II regarding the frequency of maintenance of prosthetic parts of both types of restorations. There was a statistically significance difference between group I and group II regarding the frequency of maintenance of implant components. At 6‐ and 12‐month observation periods, group I showed statistically significant lower mean plaque index, gingival index, and pocket depth compared with group II (P .05). There was no difference in the frequency of maintenance of prosthetic parts between fixed screw retained restorations and ball retained over denture while the fixed screw retained restorations showed lower rate of maintenance of implant components. The screw retained group was more vulnerable than the ball group with respect to maintaining peri-implant tissue health.

Patient satisfaction and survival of maxillary overdentures supported by four or six splinted implants: a systematic review with meta-analysis

BackgroundImplant-supported overdentures offer enhanced mechanical properties, which lead to better patient satisfaction and survival rates than conventional dentures. However, it is unclear whether these satisfaction levels and survival rates depend on the number of implants supporting the overdenture. Therefore, this systematic review aimed to compare maxillary overdentures supported by four or six splinted implants in terms of patient satisfaction, implant survival, overdenture survival, and prosthodontic complications.MethodsCochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (PubMed), and EMBASE databases were systematically searched and complemented by hand searching from 2000 to 2019, employing a combination of specific keywords. Studies comparing the use of four versus six implants for supporting overdentures with at least one-year of follow-up after prosthesis installation and including ten fully edentulous patients were included. The risk of bias (RoB) was analyzed with Cochrane’s RoB 2 and Newcastle–Ottawa tools. Implants and prosthesis survival rates were analyzed by random-effects meta-analysis and expressed as risk ratios or risk differences, respectively, and by the non-parametric unpaired Fisher’s test.ResultsA total of 15 from 1865 articles were included, and reported follow-up times after implant placement ranged from 1 to 10 years. Irrespective of the number of implants used, high scores were reported by all studies investigating patient satisfaction. Meta-analysis and non-parametric Fisher’s test showed no statistical differences regarding the survival rate of implants (P = 0.34, P = 0.3) or overdentures (P = 0.74, P = 0.9) when using 4 versus 6 splinted implants to support overdentures, and no significant differences regarding prosthodontic complications were found between groups. Randomized studies presented high RoB and non-randomized studies presented acceptable quality.ConclusionsWithin the limits of this systematic review, we can conclude that the bar-supported overdenture on four implants is not inferior to the overdenture supported by six implants for rehabilitating the edentulous maxilla, in terms of patient satisfaction, survival rates of implants and overdentures, and prosthodontic complications.

Immediate Loading of Implants Placed by Guided Surgery in Geriatric Edentulous Mandible Patients.

The aim of this study was to show the clinical outcomes of the immediate loading of implants inserted by guided surgery in edentulous mandible patients. Edentulous mandible patients were diagnosed with oral examination, cone beam computerized tomography and diagnostic casts for intermaxillary relations and treated with 8–10 implants for rehabilitation with guided surgery and immediate loading. After flapless surgery, implants were loaded with an immediate acrylic temporary prosthesis. After a period of six months, a ceramic definitive full-arch prosthesis was placed. A total of 22 patients (12 females and 10 males) were treated with 198 implants. Eleven patients (50%) had a previous history of periodontitis. Six patients (27.3%) were smokers. The follow-up was 84.2 ± 4.9 months. Clinical outcomes showed a global success rate of 97.5% of implants. Five implants were lost during the healing phase with provisional prosthesis. Twenty-two fixed full-arch rehabilitations were placed in the patients over the 193 remaining implants. Mean marginal bone loss was 1.44 mm ± 0.45 mm. Six patients (27.3%) showed some kind of mechanical prosthodontic complication. Eighteen (9.3%) of the 193 remaining implants were associated with peri-implantitis. The antecedents of peri-implantitis are critical elements for the survival of the implants. The loss of implants was significant in patients who smoked up to 10 cigarettes, compared to non-smokers. Peri-implantitis is one of the key elements in the long-term follow-up of implants and it was more manifest in smoking patients, and in those with a history of peri-implantitis. Marginal bone loss was more significant in smokers. Full-arch rehabilitation is presented as a predictable alternative with minor fatigue problems that are easily solvable.

Clinical Outcomes of Endodontic Treatments and Restorations with and without Posts Up to 18 Years

Background: The aim of this study was to collect long-term restorative and endodontic outcomes of endodontically treated teeth (ETT). Methods: 298 teeth were included in the study and were recalled up to 18 years with a media of 10.2 years. At baseline, 198 sample teeth (66.44%) showed symptoms and 164 (55%) had periapical radiolucency. The most frequently used obturation techniques were warm gutta-percha in 80% of cases, and by carrier in 20%. A total of 192 ETT were restored by direct resin composite restorations, and 106 posts were luted. Moreover, 75 (25.16%) direct restorations remained as final restorations, 137 single crowns (45.97%), 42 (14.09%) partial adhesive crowns, and 42 (14.09%) abutments of fixed bridges were the final treatments. Descriptive and inferential statistics were performed (α = 0.05). A Cox regression model was made. Results: results showed success for 92.6% of ETT up to 18 years, 2.68% (8 ETT) showed irreversible failures, and 14 (4.69%) reversible complications. Four ETT (1.34%) failed because of root fracture and the other four (1.34%) because of endodontic complications. Eight ETT (2.69%) showed non-irreversible periodontal complications and the other six (2.01%) prosthodontic complications. Accordingly, with Kaplan–Meier analysis, the survival rate after 18 years was 97.3% (Interval of Confidence (IC) 95.1–98.3). The presence of a short or long (at least 1 mm related to radiographic apex) quality endodontic filling displayed a statistically significant higher risk of complication (hazard ratio (HR) = 17.00 (IC 5.68–56.84). Furthermore, a clinically detectable not precise coronal margins predicts the presence of any clinical complication with a hazard ratio almost seven times higher than endodontically treated teeth with a proper margin (HR = 6.89 (IC 2.03–23.38)), while the presence of lucency at the baseline did not affect the risk of complication (HR = 0.575 (IC 0.205–1.61)). The presence of post, tooth position in the arch, and the type of it did not show a high-risk rate (HR = 1.85, 1.98, and 2.24, respectively). Conclusions: a correct filling (at the apex) of root canals combined with proper coronal margins allow obtaining a long-term high success rate in teeth with a periapical lesion at the baseline. The use of a post or not, when its placement is related to the residual amount of the crown, does not change the final outcome of the ETT.

Mandibular implant-supported overdenture: A systematic review and meta-analysis for optimum selection of attachment system.

Aim:This systematic review aimed to compare different attachment systems used in mandibular implant supported overdentures by assessing outcomes such as prosthodontic maintenance and complication, peri implant tissue changes, retention, and patient satisfaction for optimum selection of attachment system.Settings and Design:This systematic review conducted following Preferred Reporting Items for the Systematic Review and Meta Analysis (PRISMA) guidelines.Materials and Methods:A systematic electronic literature search was conducted through PubMed, The Cochrane Central Register of Controlled Trials (Central), and Science direct. A hand search was also performed for individual journals and reference lists of selected studies. Randomized controlled clinical trials and crossover clinical trials from 2010 to 2020 with follow up of more than 1 year were included. The Cochrane Collaboration's tool was used for assessing the risk of bias of included studies.Statistical Analysis Used:The statistical meta analysis was performed using Review Manager (RevMan) [computer program]. Version 5.4. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboation, 2020.Results:Six studies that met the inclusion criteria possess the low risk of bias with follow up of more than 1 year were included in this systematic review. Out of four outcomes, meta analysis was performed for prosthodontic maintenance and peri implant tissue changes. Due to the limited availability of data, retention and patient satisfaction were reviewed systematically without meta analysis. The result of meta analysis for ball versus magnet attachment showed statistically significant differences in prosthodontic complications and maintenance, and ball attachment reported fewer complications than the locator attachment (risk ratio [RR] =0.55, confidence interval [CI] =95%, P = 0.03). Peri implant tissue changes were analyzed in the included studies as probing depth and marginal bone loss. The result of meta analysis for probing depth showed no statistically significant difference between bar versus telescopic type of attachment (RR = 0.20, CI = 95%, P = 0.74). The meta analysis results for marginal bone loss showed no statistically significant difference between bar versus telescopic type of attachment (mean difference = 0.35, CI = 95%, P = 0.10).Conclusion:It can be concluded from the current review that bar attachment provided the most superior retention. The telescopic attachment system not only showed the most favorable patient's satisfaction but also reported the least peri implant mucosal changes. The ball attachment system is a favorable choice for limited inter arch space and parallel implant placement.

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English

A prospective cohort on the incidence of fractures in single-implant mandibular overdentures

ObjectiveDenture fracture is one of the most common complications in prosthodontics and implant overdentures are reported to be at higher risk of fractures. Therefore, the aim of this study was to assess the incidence and factors associated with the occurrence of fractures in patients treated with a single implant mandibular overdenture (SIMO) opposed by a conventional maxillary complete denture. MethodsA cohort of 152 patients, 65.1% female and 34.9% male, mean age 65.4 ± 8.5 years, were prospectively followed-up for a minimum of 1 year and up to 6.7 years. Patients received a single midline mandibular implant with a retention system incorporated in the overdenture: Straumann ball abutment and gold elliptical matrix (n = 37), Neodent ball/nylon matrix (n = 83), or Neodent Equator/nylon matrix (n = 32). Fracture was defined as a complete separation of denture parts and classified as midline fracture (over the implant region), or elsewhere. No metal reinforcement was incorporated into the overdenture. Incidence rates, life table analysis, Kaplan–Meier, and Cox regression were used for data analysis. ResultsOverdenture fractures occurred in 49 patients (32.2% incidence), with repeated fractures in 16 patients. The majority of fractures were associated with function (42.6%) or due to the overdenture being dropped (36.8%). Overall incidence density was 0.14 fracture/patient/year. The risk of fracture was associated with the duration of the overdenture use (HR = 0.84; 95%CI = 0.71–0.99). ConclusionMidline denture fracture was a common complication in patients receiving SIMO treatment regardless of the implant / retention system. The use of metal reinforcement may be considered to reduce the risk of recurrent fractures. Clinical SignificanceThis clinical prospective study showed that single-implant mandibular overdentures are at high risk of midline fractures. Proper post-insertion monitoring and the identification and management of patient’s individual risk factors are essential for the successful treatment in the long-term.

Treatment Outcomes of Implant-Supported Maxillary Obturator Prostheses in Patients with Maxillary Defects: A Systematic Review.

To systematically review the current evidence on clinical and patient-reported outcomes of implant-supported palatal obturator prostheses. An electronic search of the PubMed, Web of Science, and Cochrane databases was carried out in June 2019. The titles and abstracts of all articles were screened by two independent reviewers. The references of the subsequently selected studies were further screened for potential articles. Assessment of the selected full texts was performed independently according to established inclusion and exclusion criteria. The quality of the selected studies was determined using the Newcastle-Ottawa scale. Interrater agreement on study selection was calculated using Cohen kappa statistic. The search yielded a total of 2,797 records. Ten studies were selected for data extraction, with a Cohen kappa value of 0.856. Five studies were prospective, and five were retrospective. The survival rates for conventional implants ranged from 21.42% to 100%, whereas for zygomatic implants, the survival rates varied from 30% to 100%. Four studies reported prosthodontic complications, with screw loosening being the most common. Patient quality of life (QoL) was analyzed in six studies. In spite of the limitations of the present review, it can be concluded that the clinical outcomes are acceptable in terms of survival rates, implant and prosthodontic complications, and QoL associated with implant-supported maxillary obturator prostheses. QoL of implant-supported prostheses in these patients are acceptable. The general study design was not homogenous between studies.

The Role of FSH in Osteoporosis and Subsequent Oral Disease

Osteoporosis is an age‐related chronic disease in which osteoclasts degrade minerals of the bone faster than osteoblasts can replace them. In addition to increased risk of fracture, osteoporosis patients experience oral, dental and prosthodontic complications due to degradation of the alveolar and jaw bone. Elderly women are disproportionately impacted by this disease. One potential culprit for the gender‐based disparity is the increased levels of follicle stimulating hormone (FSH) during menopause. An isoform of the FSH receptor can be found on osteoclasts; when FSH binds to this receptor, osteoclast activity and differentiation are increased. Murine monocytes were differentiated into osteoclasts using RANK ligand, and FSH dependent signaling was measured through western blotting. Protein phosphorylation was detected in response to FSH in osteoclasts. A better understanding of the osteoclast FSH receptor could allow for pharmaceutical intervention to interrupt the pathway. Negative allosteric modulators (NAMs) that inhibit FSH signalling on granulosa cells could be used for inhibiting FSH signalling on osteoclasts.

Brånemark Novum Immediate Loading Rehabilitation of Edentulous Mandibles: Case Series with a 16-Year Follow-up.

The aim of the present report was to evaluate the clinical outcomes of edentulous jaws rehabilitated with the Brånemark Novum protocol over a 16-year period. Between April and November 2001, four patients (three males, one female) were rehabilitated with fixed full-arch rehabilitations supported by three immediately loaded implants following the Brånemark Novum protocol. Cumulative survival rates (CSRs) of the implants and prosthesis, bleeding on probing (BOP), Plaque Index (PI), probing depth (PD), implant stability quotient (ISQ; as measured through resonance frequency analysis [RFA]), and peri-implant bone resorption were evaluated over time, up to the 16-year follow-up. At 16 years of follow-up, no implant failed (CSR 100%) and no prosthesis needed to be substituted (CSR 100%). During the period between the 11th and 16th year of follow-up, bone level (mean: 2.2 mm at 16 years) and RFA values remained stable. At the 16-year follow-up, the implants presented high PI (79.2%) but low BOP (10.4%) values. Mean PD was 3.30 mm (range: 2 to 6 mm). One biologic complication was detected on a central implant (crater-form bone destruction), and several prosthodontic complications occurred during the 16 years (fractures of resin or teeth), the majority of which were registered on the same parafunctional patient. This is the first description of the Brånemark Novum protocol rehabilitation with a 16-year follow-up. The outcomes demonstrated very good long-term outcomes for this protocol.

Comparative evaluation of BioHPP and titanium as a framework veneered with composite resin for implant-supported fixed dental prostheses

Statement of problemHigh rates of veneering chipping are a common prosthodontic complication of restorations with a titanium framework. A new bio high-performance polymer (BioHPP) based on polyetheretherketone (PEEK) has been introduced for denture superstructures. Clinical reports suggest that BioHPP could be used as an alternative framework material to support complete-arch restorations. However, peer-reviewed information is lacking regarding the performance of BioHPP as a framework material for implant-supported screw-retained fixed dental prostheses (FDPs) veneered with composite resin. PurposeThe purpose of this in vitro study was to evaluate and compare the bond strength of modified PEEK (BioHHP) and titanium with a veneering composite resin and compare the marginal fit and fracture resistance of implant-supported screw-retained FDPs fabricated by using computer-aided design and computer-aided manufacturing (CAD-CAM) frameworks veneered with composite resin. Material and methodsA composite resin was bonded to 2 framework materials (n=20/group): pure titanium (Ti) and BioHPP (Bi). The shear bond strength (SBS) was determined after 24-hour wet storage. Furthermore, 20 3-unit CAD-CAM BioHPP and titanium frameworks were fabricated (n=10/group). The marginal fit between frameworks and abutments was evaluated by scanning electron microscopy by using the single-screw test. After thermocycling and mastication simulation, the fracture resistance of FDPs veneered with the composite resin was examined. The independent sample t test was used to evaluate differences (α=.05). ResultsSignificantly higher shear bond strengths were obtained in group Bi (31.1 ±3.5 MPa) than in group Ti (20.5 ±1.8 MPa). The mean marginal gap width was 19 ±4 μm in group Bi and 16 ±6 μm in group Ti. Statistical tests showed no significant differences (P>.05). After loading, veneering chipping was observed at a load of 1960 ±233 N in group Ti. Although the BioHPP frameworks fractured at 1518 ±134 N, no chipping occurred. ConclusionsThe bond strength of BioHPP with the composite resin was greater than that of titanium. CAD-CAM BioHPP frameworks exhibit good marginal fit and fracture resistance. BioHPP may be a suitable alternative to metal as a framework to be veneered with composite resin.

Comparison of three different types of implant-supported fixed dental prostheses: A long-term retrospective study of clinical outcomes and cost-effectiveness.

To study the performance of 2-3 posterior bone-level dental implants constructed with either three non-splinted crowns (NSC), three splinted crowns (SC), or a 3-unit implant-supported bridge over two implants (ISB). Patients treated with three metal-ceramic NSC, SC, or an ISB were included in the present retrospective study. Implant survival and success rate as well as all biological and technical complications were collected. The cost associated with each of the treatment options was evaluated in the comparative analysis. One hundred and forty-five patients (40 NSC, 52 SC, and 53 in the ISB) receiving 382 bone-level implants (120 NSC, 106 ISB, and 156 SC) were included (mean follow-up of 76.2months). Lack of success was observed in 33.8% of the total patient sample, being lower in the ISB group.Implant survival rates were 92.5% in the NSC, 100% in the ISB, and 88.5% in the SC, with significant difference noted between the ISB and SC (p=0.01). Overall, 9.9% of the total implants were found to have peri-implantitis (PI), with 16.7% in the SC, 7.5% in the NSC, and 2.8% in the ISB. Patients presenting prosthodontic complications were significantly higher in NSC (32.5%) than ISB (13.2%) and SC (15.4%). The total cost of the ISB group was significantly lower when compared to the NSC and SC groups (p<0.001). An 3-unit implant-supported bridge restoring 2 implants seems to present the most ideal long-term therapeutic solution, among the investigated approaches in this study, in rehabilitating a 3-unit edentulous area.

Prosthodontic Complications of Metal-Ceramic and All-Ceramic, Complete-Arch Fixed Implant Prostheses with Minimum 5 Years Mean Follow-Up Period. A Systematic Review and Meta-Analysis.

The purpose of this systematic review and meta-analysis was to review and analyze the prosthodontic complications, survival, and success of metal-ceramic (MC) and all-ceramic (AC) complete-arch fixed implant dental prostheses (CFIDPs) with a minimum mean follow-up period of 5 years. A structured literature search was conducted using 3 electronic databases (MEDLINE, the Cochrane Library, Web of Science) for clinical studies reporting on prosthodontic complications of metal-ceramic and/or all-ceramic CFIDPs published between 2000 and 2016. This was complemented with hand searching in relevant journals, references, as well as searching in grey literature. Risk of bias analysis for randomized controlled trials was done following the recommendations from the Cochrane Collaboration. Quality appraisal for nonrandomized studies was executed according to the Newcastle-Ottawa scale (NOS). The final selection included only studies with a minimum mean follow-up time of 5 years. The electronic databases search yielded 1804 relevant titles and abstracts; 11 studies were finally selected (9 for MC and 2 for AC CFIDPs). Risk of bias in most selected studies was low. Heterogeneity across studies of MC CFIDPs was within acceptable range but not among AC CFIDP studies, so no meta-analysis was performed for the latter. Regarding MC CFIDPs, most studies recorded 100% survival rate (survival range: 92.4-100%, success range: 47-96.7%), with veneer fracture being the most-common complication. Five- and 10-year cumulative complication rates for MC CFIDP veneer fractures were 22.1% and 39.3%, respectively, but with variable confidence intervals. The 2 studies included for AC CFIDPs reported 100% survival rates but differed in success rates, with the one using predominantly monolithic zirconia restorations reporting 90.9%, and the one using bi-layered zirconia reporting 60.4%, with complications attributed to veneer fracture. MC and AC CFIDPs presented with veneer fractures as primary complication. This may require significant maintenance. Other complications were negligible after a mean follow-up period of at least 5 years. More long-term studies, especially on all-ceramic CFIDPs are needed.

Overdenture Prostheses with Metal Copings: A Retrospective Analysis of Survival and Prosthodontic Complications.

To retrospectively evaluate complications associated with overdentures and abutment teeth restored with metal copings, including post-procedural and prosthetic problems; also to analyze the frequency and influencing factors associated with these problems. A total of 80 subjects (48 females, 32 males, mean age 62years) wearing root-supported overdentures were enrolled in the study. All participants were thoroughly examined by a single examiner, and appropriate maintenance care was performed. The 80 subjects had 270 abutments, which were endodontically treated teeth. All 80 subjects were carefully interviewed, inspected, and evaluated for post-procedural and clinical problems with their overdentures for an observation period of up to 5 years. Of the post-procedural problems evaluated, the most common problems were gingival inflammation (69%) and root caries (36%) because of poor oral hygiene (41%) and loss of metal copings (34%), followed by overdenture base fracture over abutment teeth (34%). Other post-procedural problems reported were loss of overdenture stability (23%), incidence of overdenture repair (20%), poor retention (18%), incidental finding of root fragments (unplanned) in the jaws (15%), and up to two grade net change in the mobility of overdenture abutments (8%). All prostheses were in use at the time of data collection and observation up to 5 years. Overdenture therapy was satisfactory; however, post-procedural and prosthetic complications and aftercare maintenance must not be underestimated.

Managing complications resulting from limited prosthetic space with a monolithic, multichromatic CAD-CAM implant-retained overdenture: A dental technique

This article proposes a 2-visit clinical protocol to manage prosthodontic complications resulting from limited prosthetic space, using a monolithic, multichromatic computer-aided design and computer-aided manufacturing (CAD-CAM) acrylic resin implant overdenture. The advantages and limitations of using this approach are outlined and discussed.

Long-term treatment outcome and influencing factors of teeth receiving modified crown lengthening

Objective: To observe the long-term clinical treatment outcome and the influencing factors of the outcome for the teeth receiving modified crown lengthening surgery combined with root canal treatment and post-core crown restoration. To summarize the clinical guidelines of modified crown lengthening surgery in selection of indications and for mulation of treatment planning. Methods: Fifty-seven patients with a total of 67 teeth receiving modified crown lengthening surgery combined with root canal treatment and post-core crown restoration for at least a 6 months' follow-up period between July 2004 and July 2013 were recruited in this retrospective study by phone call interviews. The patients' clinical outcomes were evaluated by the combination of clinical examination, radiograph and questionnaire regarding patient-reported outcome of the last follow up (≥9 months post modified crown lengthening surgery and ≥6 months after definite crown restorations). All of the treated teeth were classified into two groups, group A (teeth with good clinical treatment outcome) and group B (teeth with poor clinical treatment outcome), based on the defined criteria including patients' satisfaction with the function and esthetics of the teeth and absence of periodontal, endodontic and prosthodontic complications. The potential influencing factors of clinical treatment outcome were also determined by Logistic regression analysis. Results: Vertical root fracture in 1 tooth was found on its periapical film and the tooth was deemed hopeless. Thus, the survival rate is 99% (66/67) for the multidisciplinary treatment approach. Seventy-two percent (48/67) of the teeth achieved good clinical treatment outcome and 28% (19/67) of the teeth developed one or several complications. In group B (teeth with poor clinical treatment), 16 out of teeth exhibited periodontal complications with bleeding on probing (BOP) positive mostly found. Logistic regression analysis demonstrated that plaque control (OR=21.392, P=0.014), edge form (OR=7.610, P=0.011), and smoking experience (OR=7.315, P=0.018) were the risk factors influencing the clinical treatment outcome of modified crown lengthening surgery combined with root canal treatment and post-core restoration. Conclusions: Modified crown lengthening surgery combined with root canal treatment and post-core restoration has a good and stable clinical effect in the observational time of 6-114 months. Plaque control, smoking status and edge form of the tooth appeared to be the influencing factors of this multidisciplinary treatment approach.